病人自治、尊嚴死亡與最佳利益原則

傳統的父權型醫療模式面臨病人缺乏自治、醫患關係緊張等挑戰，有必要基於病人自治理念，確立病人自主權的權利體系，推動由醫生主導向病人自治的醫患關係轉型。在病人自治體系中，臨終自治牽涉生命安全與生命尊嚴，是最重要也是最需要法律保障的自治。從松解自殺禁令，到允許撤除延命醫療措施，再到允許醫生協助自殺，以臨終自治為核心的尊嚴死亡法律制度不斷發展演變。立足尊嚴死亡理念，為避免無效、過度醫療，需要確立和保障病人的臨終自治權利，包括拒絕侵入性過度搶救措施，拒絕或者撤除延命醫療措施，選擇臨終安寧療護方案，以及選擇醫生協助終止生命等。鑒於病人臨終自治面臨失能後的決策能力困境，以及自身的理性決策局限，需要基於病人最佳利益原則，系統地構建尊嚴死亡法律制度。

The traditional paternity-featured medical model is confronted with patients' lack of auton-omy and an uneasy relationship between physicians and patients, calling for autonomic rights of patients based on the notion of patients' autonomy and prompting the transition from physicians' domination to patients' autonomy. Within the system of patients' autonomy, the autonomy of dying persons, in consid-eration of security and dignity, deserves legal protection. From loosening the prohibition of suicide to al-lowing withdrawing life-prolonging medical treatments and then to permitting physician assisted death, the patients' autonomy-oriented dignified death legal system undergoes continuous development. In order to avoid invalid and aggressive therapies, the following autonomic rights of dying persons, which origina-ted from the notion of death with dignity, should be recognized and secured; the rights of refusing offen-sive and aggressive emergency treatments, refusing or withdrawing life-prolonging medical treatments, choosing palliative treatments, and choosing terminating life with physicians' assistance. The autonomy of dying patients faces the challenges of decision-making after incapacity and the limitations of reasonable decisions. Therefore, it is necessary to establish the legal system of death with dignity based on the prin-ciple of patients' best interests.